Clinically available intracorporeal left ventricular assist devices

Area of Science:

• Cardiovascular Medicine
• Biomedical Engineering
• Surgical Technology

Background:

• Three intracorporeal left ventricular assist devices (LVADs) are commercially available.
• Current LVADs share similar flow patterns, providing significant hemodynamic support and reversing heart failure.
• Major surgery is required for implantation and explantation of all LVADs.

Purpose of the Study:

• To review the current landscape of commercially approved left ventricular assist devices (LVADs).
• To highlight similarities, advancements, and persistent challenges in LVAD therapy.
• To assess the impact of LVADs on patient survival and transplant outcomes.

Main Methods:

• Review of existing literature and Food and Drug Administration (FDA) data on approved LVADs.
• Analysis of device similarities, hemodynamic performance, and surgical requirements.
• Evaluation of complication rates, particularly device failure, thromboemboli, and infection.
• Assessment of patient survival rates pre- and post-transplant for LVAD recipients.

Main Results:

• LVADs demonstrate excellent hemodynamic support, reversing heart failure and improving the neurohormone/cytokine milieu.
• Electrically powered models enable tether-free living and hospital discharge.
• Significant reductions in device failure and thromboemboli have been observed over the past decade.
• Infection remains a primary obstacle to widespread LVAD adoption.
• Most patients (65-78%) survive to transplant with LVAD support, showing comparable post-transplant survival to non-bridged patients.

Conclusions:

• Left ventricular assist devices (LVADs) are effective in supporting patients with heart failure and improving transplant outcomes.
• Ongoing advancements are reducing device-related complications, but infection control is critical.
• Addressing the challenge of infection is expected to increase the utilization of LVADs in clinical practice.